TETANY 



181 



anticus muscle and by the dorsal flexion of the great toe. The diarrheas ceased on Feb. 

 15 (administration of tanningen), and the tetanic attacks disappeared. 



In children there occurs the so-called carpopedal spasms in which the 

 fingers do not, as in the previous case, assume the obstetrician's position, 

 but are spread out. In involvement of the face, this expresses itself in a 

 tension of the muscles, in spasm of the lids, in slight pointing of the mouth 

 (fish-mouth position, "tetany face" of Ujfenheimer), in spasms of the masse- 

 ter, of the geniohyoglossus, and hyoglossus muscles (yawning spasms), in 

 difficulty of speech on account of the tonic rigidity of the tongue, and eventu- 

 ally in convergence or strabismus with the occurrence of double vision. 

 Sometimes the trunkal, nuchal, and abdominal 

 musculature is involved. Finally the diaphrag- 

 matic and the intercostal muscles may be 

 affected, producing dyspnea. Bechterew could 

 produce spasm of the diaphragm directly by 

 pressure over the phrenic nerve. As is known, 

 the involvement of the muscles of the larynx is 

 very common in children. Here the laryngo- 

 spasm often stands well in the foreground. 

 Moreover, the rest of the respiratory muscles 

 are mostly involved. There occurs inspiratory 

 retraction, and even lightning-like closure of the 

 glottis (tetanus aponicus) ; more rarely expira- 

 tory apnea also (Eschericti). Also in adults 

 laryngospasms occur not at all rarely, as 

 Pineles points out especially. Finally we must 

 mention the rare retching spasms. In the 

 tetany of animals in which the parathyroids 

 have been removed, these occur not at all 

 rarely; here it is associated with vomiting. The 

 transversely striated sphincters of the bladder 

 and rectum for the most part remain free, al- 

 though difficulty in urinating is sometimes seen 

 (v. Frankl-Hochwart] . 



The duration of the spasms is often very 

 short, although at times it is hours long. The 

 patients often sit for a long time with retracted abdomen, the extrem- 

 ities in the position described, incapable of movement. Sometimes there 

 occurs only a single spasmodic attack; in other cases the attacks are 

 repeated at longer or shorter intervals; in children are observed as many 

 as eighty laryngospastic attacks a day. 



The most manifold factors may bring about the spasm. In acute cases 

 a slight excitation, percussion of the abdominal musculature, may lead to a 



FIG. 25. Obstetrician's posi- 

 tion of the hands in tetany. 



